| Parents, pediatricians and mental health professionals alike are increasingly concerned about a malady that seems to be affecting more and more adolescent girls today, especially in urban India—Anorexia Nervosa. Literally meaning ‘loss of appetite’, it usually begins in young people around puberty, who intentionally starve themselves to lose weight, triggering off an eating disorder. They go on strict diets, which are highly inappropriate and unrealistic, in search of that elusive, ‘ideal’ figure. Convinced that they are overweight even when they are bone-thin and emaciated, they punish themselves severely to the point of starvation, at times leading even to death.
Ninety per cent of anorectics are girls between 13 and 20 years, though more young boys and men also seem to be increasingly prone to it. Known also as the ‘slimmer’s disease’, it is more common in upper middle class girls who probably had a previous history of obesity or displayed strange food fads.
Jyoti developed anorexia when she was 16. An obedient girl, shy and studious, she tried hard to please everyone. Though attractive she was slightly overweight and a casual remark by her brother that she would never find a boyfriend if she didn’t lose weight, set off a pattern of relentless dieting—never believing she was thin enough even when she was grossly underweight. She became obsessed with dieting and food that she developed strange eating rituals—measuring and weighing everything that she ate and drank, religiously noting the details down in a diary. She exercised compulsively everyday even if she was fainting with exhaustion and fatigue. She would induce vomiting soon after she ate or use laxatives and diuretics to control her weight. She was totally obsessed with her body image and became depressed and sleepless, worrying about being fat, contemplating suicide at times. Soon, she stopped menstruating, along with her rapid weight loss.
Complications of anorexia
Apart from psychological symptoms such as distorted body image, social withdrawal, outbursts of aggression, depression, suicidal ideas or obsessive compulsiveness, profound physical symptoms also occurs. These include loss of hair, dry skin, cessation of menstruation, constipation, intolerance of cold temperatures and low pulse rate. Starvation causes damage to vital organs of the body such as the heart and brain. Mild anaemia, swollen joints, reduced muscle mass and light-headedness commonly occur in anorexia.
What causes anorexia?
Anorexia nervosa is an illness of several causes—a combination of personality factors, family environment, societal trends, biochemical changes in the brain and endocrine system.
The personalities of the girls who become vulnerable to the illness tend to be conformist, obedient, hard working, ‘eager to please’, and ‘too good to be true’, types. They also have low self esteem, feelings of helplessness and a fear of becoming fat.
Eating disorder seems to run in families, suggesting genetic factors may predispose some people to it. However, family and environmental factors such as high expectations to achieve or perform, a mother overly concerned with her daughter’s weight and figure, or a brother/father who are highly critical about her physical appearance put the girls at an increased risk for anorexia. People in professions that place a premium on ‘thinness’ like modeling, dancing, gymnastics, athletics may be more susceptible.
In addition, certain biochemical changes in the brain (hypothalamus) and hormonal system which regulates the body functions including eating and digestion, are seriously disturbed.
Treatment of anorexia
Anorexia is most successfully treated when diagnosed early, but unfortunately, awareness about the illness is virtually absent. The anorectic may not receive medical or psychological attention until she has become dangerously thin and malnourished. A multidisciplinary team approach is required in treating anorexia.
- The first step is a complete physical examination to rule out any other illness.
- Then determine whether the patient is in critical medical danger and requires hospitalisation to manage any complication arising due to it by the physician.
- Plan gradual weight gain by re-establishing normal eating patterns with the help of a nutritionist.
- Psychiatric medication for treating risk of suicide, depression, anxiety or obsessive compulsive symptoms.
- Psychotherapy, for dealing with emotional issues, faulty family interaction patterns, increasing the patient’s ability to cope with the illness and changing abnormal thought patterns.
- Behavior therapy that focuses on changing eating behaviors, through rewards and punishments or modeling appropriate eating behaviors.
- Group therapy can be of immense help in offering emotional support through shared experiences of others with similar problems.
The treatment is often difficult, time consuming and at times even frustrating as progress is slow and relapses are common and follow up therapy of 3-5 years is recommended.
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